JAMIA Study: EHR Adoption Requires Multi-Pronged Strategy

Health IT has been proven to improve efficiency, reduce medical errors and raise quality of care. So why is it, that even in a progressive state like Massachusetts, most small office practices still have not adopted electronic health records (EHRs)?

"We have still a long way to go," admits Dr. Steven R. Simon, lead author of a statewide study published in the current Journal of the American Medical Informatics Association (JAMIA). The survey of 1,345 physicians, conducted last spring, showed that almost half of Massachusetts physicians use EHRs but only about one in four office practices have adopted the technology. Respondents identified start-up financial costs as barriers (84 percent), as well as concerns about loss of productivity (81 percent). Physicians also had concerns about technical factors, such as lack of computer skills and technical support.

"That's the paradox: When you talk to physicians about the benefits of EHR, physicians think they will do good things. But they themselves say, 'I know all that, but I can't do it,' " says Simon, who is assistant professor of ambulatory care and prevention at Harvard Medical School and Harvard Pilgrim Health Care.

While the Bay State EHR adoption rate for individual physicians is more than double the national average (45 percent vs. 18 percent), many of these physicians are concentrated in "large, financially stable multi-specialty groups" tied to hospitals or teaching practices, such as Partners, CareGroup, Boston Medical Group and Harvard Vanguard. EHR adoption was strongly tied to the size of the practice, with 52 percent of practices with seven or more physicians reporting using an EHR, as compared with just 14 percent of solo practices.

The study echoed the results of a similar analysis conducted in Florida last year, which also showed a strong correlation between practice size and EHR adoption. Dr. Nir Menachemi, lead author of that study, published in the summer 2006 Journal of Healthcare Information Management, says, "This trend is probably attributable to the economies of scale that larger practices have in terms of increased access to both financial and human resources."

But, it's not just a matter of economics, says Micky Tripathi, CEO of Massachusetts eHealth Collaborative, which has been helping establish EHRs in several communities. "We can't just pour financial resources toward the problem. We need a multi-pronged approach that addresses project management problems and security and privacy concerns."

The JAMIA survey found that for the majority of physicians, decision-making about EHRs is done on the practice level; fewer than three in ten physicians indicated that state or national entities such as a state medical society, managed care plans, or organizations such as the Leapfrog Group influenced their decisions.

"These changes take time," says Dr. Dale Mcgee, president-elect of the Massachusetts Medical Society. "In the end, what we see as the biggest challenge is trying to reach out to small and medium size practices and providing them with resources. We have a lot to nibble away at."

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